EANM procedure guideline for radio-immunotherapy for B-cell lymphoma with 90Y-radiolabelled ibritumomab tiuxetan (Zevalin)

  • Jan Tennvall
  • Manfred Fischer
  • Angelika Bischof Delaloye
  • Emilio Bombardieri
  • Lisa Bodei
  • Francesco Giammarile
  • Michael Lassmann
  • Wim Oyen
  • Boudewijn Brans



In January 2004, EMEA approved 90Y-radiolabelled ibritumomab tiuxetan, Zevalin, in Europe for the treatment of adult patients with rituximab-relapsed or -refractory CD20+ follicular B-cell non-Hodgkin’s lymphoma. The number of European nuclear medicine departments using Zevalin is continuously increasing, since the therapy is often considered successful. The Therapy, Oncology and Dosimetry Committees have worked together in order to define some EANM guidelines on the use of Zevalin, paying particular attention to the problems related to nuclear medicine.


The purpose of this guideline is to assist the nuclear medicine physician in treating and managing patients who may be candidates for radio-immunotherapy. The guideline also stresses the need for close collaboration with the physician(s) treating the patient for the underlying disease.


Guidelines Nuclear medicine 90Y-ibritumomab tiuxetan Non-Hodgkin’s lymphoma Radioimmunotherapy 



The European Association of Nuclear Medicine has written and approved guidelines to promote the cost-effective use of high-quality nuclear medicine procedures. These generic recommendations cannot be rigidly applied to all patients in all practice settings. The guidelines should not be deemed inclusive of all proper procedures or exclusive of other procedures reasonably directed to obtaining the same results. Advances in medicine occur at a rapid rate. The date of particular guidelines should always be considered in determining their current applicability.


  1. 1.
    Chinn PC, Leonard JE, Rosenberg J, Hanna N, Anderson DR. Preclinical evaluation of 90Y-labeled anti DC20 monoclonal antibody for treatment of non-Hodgkin’s lymphoma. Int J Oncol 1999;15:1017–25.PubMedGoogle Scholar
  2. 2.
    Goldenberg DM. Advancing role of radiolabeled antibodies in the therapy of cancer. Cancer Immunol Immunother 2003;52:281–9.PubMedGoogle Scholar
  3. 3.
    Fischer M, Behr T, Grünwald, Knapp WH, Trumper L, von Schilling C; German Society for Hematology and Oncology. Guideline for radioimmunotherapy of rituximab relapsed or refractory CD20+ follicular B-cell non-Hodgkin’s lymphoma [in German]. Nuklearmedizin 2004;43:171–6.PubMedGoogle Scholar
  4. 4.
    Griesinger F, Trümper L, Becker W. Radioimmunkonjugate: Therapie von Non-Hodgkin-Lymphomen und kolorektalen Karzinomen. Der Internist 2001;42:860–73.PubMedCrossRefGoogle Scholar
  5. 5.
    Juweid ME. Radioimmunotherapy of B-cell Non-Hodgkin’s lymphoma: from clinical trials to clinical practice. J Nucl Med 2002;43:1507–29.PubMedGoogle Scholar
  6. 6.
    Hagenbeek A, Lewington V. Report of a European consensus workshop to develop recommendations for the optimal use of 90Yttrium-ibritumomab tiuxetan (Zevalin) in lymphoma. Ann Oncol 2005;16:786–92.PubMedCrossRefGoogle Scholar
  7. 7.
    Press OW, Leonard JP, Coiffier B, Levy R, Timmerman J. Immunotherapy of Non-Hodgkin’s lymphoma. Hematology 2001;221–40.Google Scholar
  8. 8.
    Wagner HN, Wiseman GA, Marcus CS, Nabi HA, Nagle CE, Fink-Bennett DM, et al. Administration guidelines for radioimmunotherapy of non-Hodgkin’s lymphoma with 90Y-labeled anti-CD20 monoclonal antibody. J Nucl Med 2002;43:267–72.PubMedGoogle Scholar
  9. 9.
    Wiseman GA, Gordon LI, Multani PS, Witzig TE, Spies S, Bartlett NL, et al. Ibritumomab tiuxetan radioimmunotherapy for patients with relapsed or refractory non-Hodgkin lymphoma and mild thrombocytopenia: a phase II multicenter trial. Blood 2002;99:4336–42.PubMedCrossRefGoogle Scholar
  10. 10.
    Wiseman GA, Leigh B, Erwin WD, Lamonica D, Kornmehl E, Spies SM, et al. Radiation dosimetry results for Zevalin radioimmunotherapy of rituximab-refractory non-Hodgkin lymphoma. Cancer 2002;94:1349–57.PubMedCrossRefGoogle Scholar
  11. 11.
    Wiseman GA, Kornmehl E, Leigh B, Erwin WD, Podoloff DA, Spies S, et al. Radiation dosimetry results and safety correlations from 90Y-ibritumomab tiuxetan radioimmunotherapy for relapsed or refractory non-Hodgkin’s lymphoma: combined data from 4 clinical trials. J Nucl Med 2003;44(3):465–7.PubMedGoogle Scholar
  12. 12.
    Wiseman GA, White CA, Sparks RB, Erwin WD, Podoloff DA, Lamonica D, et al. Biodistribution and dosimetry results from a phase III prospectively randomized controlled trial of Zevalin radioimmunotherapy for low-grade, follicular, or transformed B-cell non-Hodgkin’s lymphoma. Crit Rev Oncol Hematol 2001;39(1–2):181–94.PubMedGoogle Scholar
  13. 13.
    Witzig TE. Radioimmunotherapy for patients with relapsed B-cell non-Hodgkin lymphoma. Cancer Chemother Pharmacol 2001;48(Suppl 1):91–5.CrossRefGoogle Scholar
  14. 14.
    Witzig TE, Gordon LI, Cabanillas F, Czuczman MS, Emmanouilides C, Joyce R, et al. Randomized controlled trial of yttrium-90-labeled ibritumomab tiuxetan radioimmunotherapy versus rituximab immunotherapy for patients with relapsed or refractory low-grade, follicular, or transformed B-cell non-Hodgkin’s lymphoma. J Clin Oncol 2002;20:2453–63.PubMedCrossRefGoogle Scholar
  15. 15.
    Witzig TE, Flinn IW, Gordon LI, Emmanouilides C, Czuczman MS, Saleh MN, et al. Treatment with ibritumomab tiuxetan radioimmunotherapy in patients with rituximab-refractory follicular non-Hodgkin’s lymphoma. J Clin Oncol 2002;20:3262–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Witzig TE, White CA, Wiseman GA, Gordon LI, Emmanouilides C, Raubitschek A, et al. PhaseI/II trial of IDEC-Y2B8 radioimmunotherapy for treatment of relapsed or refractory CD20+ B-cell non-Hodgkin’s lymphoma. J Clin Oncol 1999;17:3793–803.PubMedGoogle Scholar
  17. 17.
    Witzig TE, White CA, Gordon LI, Wiseman GA, Emmanouilides C, Murray JL, et al. Safety of yttrium-90 ibritumomab tiuxetan radioimmunotherapy for relapsed low-grade, follicular, or transformed non-Hodgkin’s lymphoma. J Clin Oncol 2003;21:1263–70.PubMedCrossRefGoogle Scholar
  18. 18.
    Cheson BD, Horning SJ, Coiffier B, Shipp MA, Fisher RI, Connors JM, et al. Report of an international workshop to standardize response criteria for non-Hodkin’s lymphomas. NCI Sponsored International Working Group. J Clin Oncol 1999;17:1244–53.PubMedGoogle Scholar
  19. 19.

Copyright information

© EANM 2007

Authors and Affiliations

  • Jan Tennvall
    • 1
  • Manfred Fischer
    • 2
  • Angelika Bischof Delaloye
    • 3
  • Emilio Bombardieri
    • 4
  • Lisa Bodei
    • 5
  • Francesco Giammarile
    • 6
  • Michael Lassmann
    • 7
  • Wim Oyen
    • 8
  • Boudewijn Brans
    • 9
  1. 1.Department of OncologyLund University HospitalLundSweden
  2. 2.Im Bodden 60KasselGermany
  3. 3.Service Médecine NucléaireCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
  4. 4.Istituto Nazionale per la Cura e lo Studio dei TumoriDirezione Medicina Nucleare-Centro PETMilanItaly
  5. 5.Division of Nuclear MedicineEuropean Institute of OncologyMilanItaly
  6. 6.Service Médecine NucléaireCentre Leon BerardLyonFrance
  7. 7.Klinik und Poliklinik für NuklearmedizinUniversitaet WürzburgWürzburgGermany
  8. 8.Department of Nuclear MedicineRadboud University, Nijmegen Medical CentreNijmegenThe Netherlands
  9. 9.Department of Nuclear MedicineUniversity Medical CentreMaastrichtThe Netherlands

Personalised recommendations